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FOR OFFICE USE: ' ------------------------------------------ ------ / " :•------ - APPLICATION FOR SANITATION PERMIT Permit No. ----------- ' ---------------------------------- ---------- {Complete in Duplicate) 7� IDate Issued ----F.......:. .... --------- ----- ----------------------------------------- This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 4 JOB ADDRESS AND,LOCATION......ef------:--'Q------rG � _ e�---------------------------------- - • ---------------------------- ------------------... Owner's Name----4�-d. ----- ---------------------------------------------•---- ---- Phone..................__-------------- Address , .,-----------------------------•--•---•-..... - - Contractor's Name..------- --J _ -----------------------------------------=--=--------•----............ •-•----•••---•• Phone---•-•----•-..................... Installation will serve: 'Residence.[ Apartmenf House [I Commercial [:] Trailer Court ❑ .Motel ❑ Other E] Number of living units: --/-..Number of bedrooms .,�. Number of baths ._/.. Lot size,:4 x.x..A............................ F Water Supply: Public system jr Community system ❑ Private ❑ Depth to Water Table -49aft:' Character of soil-to a depth.of 3 feet: Sand C] Gravel E3Sandy Loam ❑`�play Loam I[] Clay C] Adobe Ej--Hardpan F]f Previous Application Made:, (If yes,date-----------:.....:...)r No [ !..New Construction:`Yes E] No []�I=HA/VA: Yes ❑ No [�}�- TYPE OF.INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within _200 feet.) W -' -Septic TanIg Distance from nearest well--------_---------Distance from ` ' • .foundation....................Mate=riayl___•____.^. t_____.___... ............................. No. ofor __ _ Size-------------------=------------Liquid dep,h_....------• `Ca acitY-------•--•-•-• ---•- Dis osal Fsiy¢ r..; ace from near.es.t . well------`":'`:Distanonce from foundat_io / Distance to 'nearest I Iine.�.�..._._._. Number of lines........ .--__.______-.__-_Lengthof each line ,f, - wWidth oftrench._ /f____•-_____._______:..._ .Typeof fltemat_er_,al. � _-Depth,of flier material____! :_.-Total length__ � _______________________r _ \ Seepage-Pif: "�.' �`Distbnce o,nearest ell--_-' ^.__-.--Distance from foundation---/tL.�.Distance fofnearest lot line.-e ...._.... Number of�piits-----�?____.______Lining material ` _.__.Size: Dia meter.��!._.___:_..Depth_-�'�..._________________ Cesspool:, Distance from 4a rest well-----------------Distance from foundation--------------------Lining material________-_--____________________.___. •. ❑ Size: Diameter--•\----I{----------�-`-----• ,......Depth----•------"•'---------•----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____________________+_____: __---�:-_---Distance from nearest buildin ...... ❑ ----- ----------- ------ -------------------------------------- •,Distance to.nearest lot line---------------- �_,�-------`'-= Remodeling and/or repairing (describe):--------------- a =---.-----'-------------•----••-----------•----•----------- it ----••---•-----------:............•.........---------------------------------••-•-•------------•----._.---.........---•------------------------------------------------ I hereby certify that I,have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andregulations of the Sart Joaquin Local Health District.' .,r :...(Signed) - -•-- ----------------------- _ orContractor) �- (Title)_ -------- ...... ----------------g ............. ---•-------------------------------- (Plot plan, showing size of lot;"location of system i r ation`to wells, buildings, etc., can be placed an reyprse'side). FOR DEPARTMENT USE ONLY >' APPLICATION ACCEPTED BY --- -- - _ - D --- ----_ ATE-3-- �2` ..•"_ 4 . REVIEWED BY--------------------------------- -------------------------- ---••--------------------------- ...... DATE.- ----------------------------------------------------- 6 BUILDING PERMIT ISSUED--.........------------------------------------------------------------------------------------------ DATE--------...----------------•---------------- eratr�ns�n orC��naIon • r .- ----------•---•--.-__--:.. ----------""-"-"--..._"-----------------------------------------------------•----------------•----------------•------------------------•----------------------------- ----------- -•--------------------------------------- FINAL INSPECTION BY:. �.. •-.----- .. -•--•------------- Date------ 3 ------------ SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 West oak STTeet ` -124dycamoro S?est 205 West 9th Street Stockton,California Lodi,California" Manf*ca,.California Tracy,California ES 9 SEVISE3 9-69 2M 5-61 ATLAS - -